OHP Family Care help

This is a question for all who have experienced OHP denial.  I am getting ready to submit my request papers. i would like to know everything I should put in the papers in hopes for a approval.  I understand denial may come first then appeal and so on.  and I also know that the doctor will tell me as well i just want to know from personal experience. my doctor wants me to have a bypass (and so do i) for preventative purposes.  I more than qualify on the BMI scale and have PCOS, sleep disturbances, hypertension, joint probs, and a few more.  But she told me to do research while we work on another more pressing problemm a hiatal hernia that is affectingn my breathing and eating, you know the daily living issues. this too caused by weight. anyways any info is more than appreciated!! My doctor already informed me that it will be a battle, but we all want to go to war prepared right?

I didnt know OHP even covered this- and am surpised they approve anyone on that insurance- as it is funded by our taxes?? Even people that really need it  that have regular insurance from there job dont have that benefit of RNY being covered- and most insurrance doesnt cover it- I dont mean to sound mean- at all!! But there are places like Mexico that it is $8000-

A lot of public assistance programs cover this now.  It's just like any other insurance -- do they use your tax dollars to continue to pay for countless medications and treatments for an unhealthy obese person, or do they allow this person to become healthy by giving them the surgery?  In the long run, many find that the surgery is more cost-effective. Linda

Thank you for your support linda! Mzy weight is an ongoing problem which is caused by a lot of things and now is causing alot more things ot go wrong.  Im sure that with alot of persistance and a list of medical problems they may consider this a need to have procedure. I can make it a living hell for them if they dont! haha just kidding!  I would have gotten this surgery along time ago if I had the resources to go to mexico or pay for it myself but they just arent availabel to me that way.  anyways thanx for the support!

April

I believe Linda is right. OHP does cover the surgery, but you have to jump through MORE hoops to get it. The government is looking at it from this point of view:

If we (govt/tax payers) don't pay for the surgery, the patient will cost us for YEARS in and out of the hospital, doctors, medications, equipment, food costs and other costs associated with obesity. BUT... if we pay a % of WLS for the patient, it will be more cost effective in the long run. I personally think it is a good idea to use tax dollars to cut the eventual costs of being Obese. Jen

The OHP does not cover any WLS as a matter of policy.  Therefore, it would be pointless to appeal any denial. I know of another poster who was denied by OHP and she found another way to have her WLS.

I actually do know someone who was covered by OHP for their surgery.  I have fallen out of contact with this person so I am unabelto ask them details.  what did this other poster do?

Here is the link to the latest info from that one poster (michv): http://www.obesityhelp.com/forums/amos/a,messageboard/action ,replies/board_id,4856/cat_id,4456/topic_id,3450683/ Her insurer is contracted thru OHP. Sorry to see that you have lost contact with the person whom you know.

This is in reply to one of the posters- unfortunately I don't really know about OHP- all I can say is you can try. But alot of insurances are covering RNY now, I think the research is showing that it is a treatment for obesity that works and as such saves them money.

Good luck with your RNY- hopefully someone out there will know something that might help you.

take care, deb366